TY - JOUR
T1 - Impact of percutaneous mitral valvuloplasty on left ventricular function in patients with mitral stenosis assessed by 3D echocardiography
AU - Esteves, William Antonio M.
AU - Lodi-Junqueira, Lucas
AU - Soares, Juliana Rodrigues
AU - Athayde, Guilherme Rafael Sant'Anna
AU - Goebel, Gabriela Assuncao
AU - Carvalho, Lucas Amorim
AU - Zeng, Xin
AU - Hung, Judy
AU - Tan, Timothy C.
AU - Nunes, Maria Carmo Pereira
PY - 2017
Y1 - 2017
N2 - Background The status of intrinsic left ventricular (LV) contractility in patients with isolated rheumatic mitral stenosis (MS) has been debated. The acute changes in loading conditions after percutaneous mitral valvuloplasty (PMV) may affect LV performance. We aimed to examine the acute effects of PMV on LV function and identify factors associated with LV ejection fraction (LVEF) changes, and determinants of long-term events following the procedure. Methods One hundred and forty-two patients who underwent PMV for symptomatic rheumatic MS (valve area of 0.99 ± 0.3 cm2) were prospectively enrolled. LV volumes and LVEF were measured by three-dimensional (3D) echocardiography. Long-term outcome was a composite endpoint of death, mitral valve (MV) replacement, repeat PMV, new onset of atrial fibrillation, and stroke. Results The mean age was 42.3 ± 12.1 years, and 125 patients were women (88%). After PMV, LVEF increased significantly (51.4 vs 56.5%, p < 0.001), primary due to a significant increase in LV end-diastolic volume (65.8 mL vs 67.9 mL, p = 0.002), and resultant increase in the stroke volume (33.9 mL vs 39.6 mL, p < 0.001). Changes in cardiac index and systolic pulmonary artery pressure were associated with LVEF changes after PMV. During a mean follow-up period of 30.8 months, 28 adverse clinical events were observed. Postprocedural mitral regurgitation, MV area, and mean gradient were independent predictors of composite endpoints. Conclusions In patients with rheumatic MS, PMV resulted in a significant improvement in LV end-diastolic volume, stroke volume and consequently increased in LVEF. Changes in cardiac index and systolic pulmonary artery pressure were associated with LVEF changes after PMV. The predictors of long-term adverse events following PMV were post-procedural variables, including mitral regurgitation, valve area, and mean gradient.
AB - Background The status of intrinsic left ventricular (LV) contractility in patients with isolated rheumatic mitral stenosis (MS) has been debated. The acute changes in loading conditions after percutaneous mitral valvuloplasty (PMV) may affect LV performance. We aimed to examine the acute effects of PMV on LV function and identify factors associated with LV ejection fraction (LVEF) changes, and determinants of long-term events following the procedure. Methods One hundred and forty-two patients who underwent PMV for symptomatic rheumatic MS (valve area of 0.99 ± 0.3 cm2) were prospectively enrolled. LV volumes and LVEF were measured by three-dimensional (3D) echocardiography. Long-term outcome was a composite endpoint of death, mitral valve (MV) replacement, repeat PMV, new onset of atrial fibrillation, and stroke. Results The mean age was 42.3 ± 12.1 years, and 125 patients were women (88%). After PMV, LVEF increased significantly (51.4 vs 56.5%, p < 0.001), primary due to a significant increase in LV end-diastolic volume (65.8 mL vs 67.9 mL, p = 0.002), and resultant increase in the stroke volume (33.9 mL vs 39.6 mL, p < 0.001). Changes in cardiac index and systolic pulmonary artery pressure were associated with LVEF changes after PMV. During a mean follow-up period of 30.8 months, 28 adverse clinical events were observed. Postprocedural mitral regurgitation, MV area, and mean gradient were independent predictors of composite endpoints. Conclusions In patients with rheumatic MS, PMV resulted in a significant improvement in LV end-diastolic volume, stroke volume and consequently increased in LVEF. Changes in cardiac index and systolic pulmonary artery pressure were associated with LVEF changes after PMV. The predictors of long-term adverse events following PMV were post-procedural variables, including mitral regurgitation, valve area, and mean gradient.
UR - https://hdl.handle.net/1959.7/uws:64476
U2 - 10.1016/j.ijcard.2017.06.078
DO - 10.1016/j.ijcard.2017.06.078
M3 - Article
SN - 0167-5273
VL - 248
SP - 280
EP - 285
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -